RESEARCH ARTICLE Br J Med Health Res.

2017;4(9) ISSN: 2394-2967

BJMHR
British Journal of Medical and Health Research
Journal home page: www.bjmhr.com

Influence of Knowledge, Attitudes and Access of Contraceptive

Methods on Unmet Need for Family Planning Among Women of
Reproductive Age in Rubavu District, Rwanda.
Bikorimana Emmanuel1*, Ngure Kenneth1, Mwaniki Peter1
1.Jomo Kenyatta University of Agriculture and Technology, School of Public Health

ABSTRACT
While achievements have been gained with modern contraceptive use rising from 10% in 2005 to
47.5% in 2015 with a resultant fall in fertility from 6.1 children per woman to 4.2 children in
Rwanda, there remain some challenges. The current study identified the influence of knowledge,
attitude, accessibility and availability of contraceptive methods on unmet need for family planning
among women of reproductive age in Rubavu District, Rwanda. A cross-sectional study was carried
among 270 women (15–49 years) attending public health facilities in western province, Rubavu
District. Semi-structured questionnaires were used to measure knowledge, attitudes and access of
contraceptive methods. The outcome variable was unmet need for family planning (unmet need for
spacing and limiting births).Bivariate analysis was done for the independent variable with the
dependent variable then multiple logistic regressions was computed. To identify the independent
effects of independent variables to unmet need for contraception, the Odds Ratio (OR) with 95%
confidence interval was computed and statistical significance was defined when p-value was less
than 0.05. The overall prevalence of unmet was 46.6% (Unmet need for spacing 27.78% and unmet
need for limiting 18.9%). After adjusting for other variables, contraceptive methods improve
standard of life (OR = 0.445, 95 % CI =0.222-0.092 , P =0.023 , Family Planning (F P) methods
cause weakness (OR = 2.879, 95 % CI =1.428-5.805, P =0.003; joint decision to use FP (OR
=0.472 , 95 % CI =0.286-0.778 , P =0.003 ), decision to use FP taken by husband (OR =2.703 , 95
% CI =1.320-5.536 , P =0.007 , were significantly associated with unmet for spacing . While FP
methods cause headache (OR = 2.240, 95 % CI =1.068-4.696, P =0.033 joint decision to use FP
(OR =0.561, 95 % CI =0.367-0.858, P =0.008), decision to use FP taken by husband (OR =2.283,
95 % CI =1.078-4.856, P =0.032 for unmet need for limiting) The attitudes that FP methods cause
weakness, FP methods cause headache and decision to use FP taken by husband increase unmet
need for family planning.
Keywords: Knowledge, Attitude, Access, Contraception, Unmet Need for Family Planning,
Women of Reproductive Age.

*Corresponding Author Email: [email protected]

Received 18 July 2017, Accepted 25 September 2017

Please cite this article as: Emmanuel B et al., Influence of Knowledge, Attitudes and Access of
Contraceptive Methods on Unmet Need for Family Planning Among Women of Reproductive Age in
Rubavu District, Rwanda s. British Journal of Medical and Health Research 2017.
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967

INTRODUCTION
Global efforts to meet the Millennium Development Goals (MDGs) have focused on increasing
access and use of modern contraceptive methods as a cross-cutting strategy for the achievement of
all eight MDGs (1). Among women in developing countries, a total of 222 million are estimated to
have an unmet need for contraception (2). To meet unmet need for family planning, the availability
of high quality family planning services must be coupled with efforts to inform potential users
about family planning and empower them to seek it(3) (5). Despite great progress over the last
several decades, big proportion of women worldwide want to prevent pregnancy, but they and their
partners are not using contraception (4). Reasons for unmet need are many: Services and supplies are
not yet available everywhere or choices are limited. Fear of social disapproval or partner’s
opposition pose formidable barriers. Worries of side effects and health concerns hold some people
back; others lack knowledge about contraceptive options and their use (WHO).Social and Behavior
Change Communication (SBCC) campaigns can inform people about the Family Planning services
available in their communities (6), combat myths and misconceptions that inhibit use, and increase
knowledge about contraceptives, including their safety, effectiveness, and side effects (7). While
achievements have been gained with modern contraceptive use rising from 10% in 2005 to 47.5%
in 2015 with a resultant fall in fertility from 6.1 children per woman to 4.2 children, there remain
some challenges (3) . Rubavu district has one of the highest unmet need for contraception in Rwanda
with 36%. Available data of 2010 RDHS showed that total fertility rate (TFR) was 5.3 children per
woman in 2010 (compared to 4.6 children at national average) and contraceptive prevalence rate
was 29.2% (16.8% lower than the national average). Infant mortality was 54 per 1000 live births
(27 per 1000 live births higher than the national average) and under-five mortality was 96 per 1000
(8)
live births (20 per 1000 live births higher than the national average . These adverse maternal and
child health outcomes associated with high TFR could be significantly reduced by meeting the
family planning (FP) needs of women in developing countries (9). Therefore the study will fill an
important gap in what is known about Rwanda’s reproductive health particularly in Rubavu district,
where very little is known about the influence of knowledge, attitude and accessibility of
contraceptive on unmet need for family planning.
MATERIALS AND METHOD
Study design
A cross sectional study was used with a quantitative approach of primary data from women of
reproductive age.
Study site
The study was conducted in Rubavu District which is located in western province, Rwanda. It has
one hospital district and 11 health centers that cover the catchment area of 404,278 inhabitants,
www.bjmhr.com 40
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
including men representing 208,938 of the population and women representing 195,340 with
women of reproductive age. Rubavu is the mostly populated district in the region (Western
Province) with 403,662 inhabitants and high population density in Rwanda (1041/km2) out of
Kigali city. The population growth rate of 3.3 with the family planning prevailing rate of 36%. (4)
Study measurements
The main independent variables for this study are Knowledge and attitude and accessibility of
contraception of women. Pregnant intended in fecund women, lactational amenorrhea, life of
celibacy are extraneous variables of the study controlled using restriction method where they have
been eliminated in order to have people of the same characteristics (fecund women). The dependent
variable of the study is unmet need for contraception defined as women of reproductive age who
were not currently using a method of family planning but wanted to postpone childbirth for more
than two years (space) or wanted to stop (limit) childbirth entirely.
Sample size and sampling
The required minimum sample size of 270 women who visited Health Centers of Rubavu district
for routine immunization of their children was determined. Probability sampling method was used
to determine the number of women from health center by which study participants will be allocated
proportionally to each health center based on number of women of reproductive age in health
center. A systematic sampling technique was used to select participants. Among women who
attended routine immunization service after examining excluding and including criteria, the list of
them was taken advantage. Choosing of a study unit (woman), the starting point was randomly
identified then every kth item from the list has been selected (where ‘k’ refers to the sampling
interval. In this case, k= population size/sample size).
Data Management and analysis
Data were collected by local trained data collectors using pre-tested semi-structured questionnaires.
Questionnaires were translated in the local language Kinyarwanda. Data were coded and SPSS 21
was used for data entry, editing and checking. Data were reentered by other than the person who
entered the data for verification. Data analysis was done according to the study objectives. A
descriptive analysis was carried out for each of the variables. Then bivariate analysis was done for
the independent variables with the dependent variable to select candidate variables for the
multivariable analyses. To assess the presence and degree of association between the dependent
and independent variables, Chi square and Fischer exact were used and statistical significance was
defined when p-value was less than 0.05.To identify factors associated with unmet need for
contraception, Odds Ratio (OR) with 95% confidence interval in multiple logistic regressions was
computed for variables which showed significant association with the dependent variable to
identify their independent effects to unmet need for contraception.

www.bjmhr.com 41
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
Ethical approval
The ethical approval was given by National Health Research Committee and Institutional Review
Board (IRB) of College of Medicine and Health Sciences at the University of Rwanda. The
participants were informed that the ethical consent will be respected. All respondents were fully
briefed about the study and its purposes. The research started interviews when written consent was
given.
RESULTS AND DISCUSSION
Unmet need for spacing and limiting by knowledge on contraceptive methods
Table 1 explains the association between existing knowledge on contraceptive methods and unmet
need for spacing and limiting. Among participants 74.8% of them know more than three methods
while 25.2% know less than three methods. Among those who know less or equal three methods
23(33.8%) have unmet need for spacing (P=0.198) and 15(22%) have unmet need for limiting
(P=0.440). Among those who know more than three methods 52(25.7%) have unmet need for
spacing (P=0.198) and 35(17.3%) have unmet need for limiting (P=0.258).The source of
information about contraceptive methods was assessed in this study. Those who have information
from radio are 33.3% while 66.7% get information from other channels. Among those who get
information from radio 27(30.0%) have unmet need for spacing (P=0.564) and 16(17.7%) have
unmet need for limiting (P=0.742). Among respondents 13(4.8%) have information from television
and 157(95.2%) do not. Among them 3(23.0%) have unmet need for spacing (P=0.698 and
4(30.7%) have unmet need for limiting (P=0.262). Friends have been involved in the study as
source of information. Among participants 46 (17.0%) they got information form their friends and
224(83.0%) do not. Of them 11(23.9%) have unmet need for spacing (P=0.521) and 8(17.3%) have
unmet for limiting (P=0.776).Who reported that they have information from health centers were
144(53.3%) while 126 (46.7%) do not. Among those who got information from health centers,
37(25.6%) have unmet need for spacing (P=0.414) and 29(20.1%) have unmet need for limiting
(P=0.575). Among respondents, 65(24.1%) have information from books while 205(75.7%) do not.
Of them 15(23.0%) have unmet need for spacing (P=0.332) and 8(12.3%) have unmet need for
limiting (P=0.120). Community health workers (CHW) were involved as source of information.
Among them 159(58.9%) got information from CHW while 111(41.1%) do not. Among those who
got information from CHW, 39(24.5%) have unmet need for spacing (P=0.154) and 24(15.0%)
have unmet need for limiting (P=0.057) .Among those who get information from community
meeting were 8(3. %) while 262(97.0%) did not. Among those who get information from
community meeting 3(37.5%) have unmet need for spacing (P=0.689) while 2(25.0%) have unmet
need for limiting (P=1.000). Respondents were asked if they know where they can get
contraceptive methods. Health centers/posts were reported .All respondents reported getting

www.bjmhr.com 42
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
contraceptive methods in health centers (constant). Among respondents 238 (88.1%) said that they
can get contraceptive methods from community health workers while 32(11.9%) cannot. Among
those who reported getting contraception form community health workers 65(27.3%) have unmet
need for spacing (P=0.640) while 46(19.3%) have unmet need for limiting (P=0.615). Those who
reported they can get contraception from pharmacy were 49(18.1%) while 221(81.9%) did not
report pharmacy. Among those reported pharmacy as source of contraceptive methods 10(20.0%))
have unmet need for spacing (P=0.203) while 7(14.2%) have unmet need for limiting
(P=0.363).Among respondents, 53(19.6%) reported that they can get contraceptives from district
hospital while 217(80.4%) did not report district hospital. Among those who reported district
hospital 18(33.9%) have unmet need for spacing (P=0.262) and 8(15.0%) have unmet need for
limiting (P=0.431).
Unmet need for spacing and limiting by attitude toward contraceptive methods
Table 2 explains the association between attitude toward contraceptive methods and unmet need for
spacing limiting. Among respondents, 211(78.1%) agree that contraceptive methods control birth
while 59(21.9%) do not agree. Among those who agree 62(29.8%) have unmet need for spacing
and those who do not agree 12(20.3%) have unmet need for spacing (P=0.149).Unmet need for
limiting counted for 44(20.8%) among those who agree and 7(11.8%) among those who disagree
(P=0.119).When asked whether contraceptive methods use improves standard of life, 215(79.6%)
approved it. While 55(20.4%) disapproved. Unmet need for spacing counted for 50(23.2%) and
25(45.4%) among those who disapproved (P=0.001).Unmet need for limiting counted for
65(30.2%) approved and 15(27.2%) among those who disapproved that contraceptive methods
improve standard of life. Among respondents 204(75.6%) agree that contraceptive methods reduce
morbidity and mortality of mothers and children while 66 (24.4%) disagree. Among those who
agree, 52(25.5%) have unmet need for spacing and unmet need for spacing counted for 23(34.8%)
among those who disagree (P=0.140). Among respondents, who agree 34(16.6%) have unmet need
for limiting and among those who disagree 17(25.7%) have unmet need for limiting (P=0.101).
Among respondents 73(27.0%) reported that contraceptive methods can cause cancer with
25(34.2%) of unmet need for spacing while 197(73.0%) said that contraceptive methods cannot
cause cancer with 50 (25.2%) of unmet need for spacing (P=0.149). Among them unmet need for
limiting counted for 15(20.5%) among those who reported that contraceptives can cause cancer and
36(18.2%) among those who said that it cannot cause cancer (P=0.672. Among participants
102(37.8%) reported that contraceptive methods can enhance marital unfaithfulness with 31
(30.3%) of unmet need for spacing while 168(62.2%) said that contraceptive methods cannot
enhance marital unfaithfulness with 44 (26.1%) of unmet need for spacing (P=0.455). Among them
unmet need for limiting counted for 24(23.5%) among those who reported that contraceptives can

www.bjmhr.com 43
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
enhance marital unfaithfulness and 27(16.0%) among those who said that they cannot enhance
marital unfaithfulness (P=0.129). Among participants 100(37.0%) reported that contraceptive
methods can decrease sexual pleasure with 39(39.0%) of unmet need for spacing while 170(63.0%)
said that contraceptive methods cannot decrease sexual pleasure with 44 (25.8%) of unmet need for
spacing (P=0.365). Among them unmet need for limiting counted for 22(22.0%) among those who
reported that contraceptives can decrease sexual pleasure and 29(17.0%) among those who said that
they cannot decrease sexual pleasure (P=0.316). Next born can have congenital malformation was
reported by 58(21.5%) with 20 (34.4%) of unmet need for spacing while 212(78.5%) did not report
it with 55(25.9%) of unmet need for spacing (P=0.198). Contraceptive methods can cause backache
was reported by 69(25.6%) with 25 (36.2%) of unmet need for spacing while 201(74.4%) did not
report it with 50(24.8%) of unmet need for spacing (P=0.069).Unmet need for limiting counted for
18(26.0%) among those who reported that contraceptives can cause backache and 33(16.4%)
among those who said that they cannot cause it (P=0.077). Contraceptive methods can cause
headache was reported by 102(37.8%) with 44 (43.1%) of unmet need for spacing while 168
(62.2%) did not report it with 31(18.4%) of unmet need for spacing (P<0.001).Unmet need for
limiting counted for 33(32.3%) among those who reported that contraceptives can cause headache
and 18(10.7%) among those who said that they cannot cause it (P<0.001). When asked that
contraceptive methods cause hypertension, 72(26.7 %) said yes with 26(36.1%) of unmet need for
spacing while 198(73.3%) said no with 49(24.7%) of unmet need for spacing P=0.065. Unmet need
for limiting counted for 17(23.6%) among those who reported that contraceptives can hypertension
and 34(17.1%) among those who said that they cannot cause it (P=0.232). Contraceptive methods
can cause weakness was reported by 115(42.6%) with 54(46.9%) of unmet need for spacing while
155(57.4%) did not report it with 21(13.5%) of unmet need for spacing (P<0.001). Unmet need for
limiting counted for 32(27.8%) among those who reported that contraceptives can cause weakness
and 19(12.2%) among those who said that they cannot cause it (P<0.001). Among participants,
89(33.0%) reported that contraceptive methods can cause weight gain with 31(34.8%) of unmet
need for spacing while 181(67.0%) did not report it with 44 (24.3%) unmet need for spacing
(P=0.070). Unmet need for limiting counted for 22(24.7%) among those who reported that
contraceptives can cause weakness and 29(16.0%) among those who said that they cannot cause it
(P<0.086). When asked that contraceptive methods can cause loss of menstruation, 81(30.0%) said
yes with 29(35.8%) while 189(70.0%) said no with 46(24.3%) of unmet need for spacing
(P<0.054). Unmet need for limiting counted for 21(25.9%) among those who reported that
contraceptives can cause loss of menstruation and 30(15.8%) among those who said that they
cannot cause it (P<0.053).Contraceptive methods might lead to permanent sterility was reported by

www.bjmhr.com 44
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
63(23.3%) with 23(36.5%) of unmet need for spacing while 207 (76.7%) did not report it with
52(25.1%) of unmet need for spacing (P=0.077).
Unmet need for spacing and limiting by availability and access of contraceptive methods
Table 3 shows the association between availability and access of contraceptive methods and unmet
need for spacing and limiting. Respondents were asked whether they know health center in the
nearby that provides FP. Of 270 who participated in the study, 269(99.6%) reported that they know
the health center in the nearby that provides FP and among them 75(27.8%) have unmet need for
spacing (P=0.100) and 51(18.9%) have unmet need for limiting (P=0.100). When asked how close
is the nearest health center, 195(72.2%) reported using less than 1 hour while 75(27.8%) use more
than one hour to reach the nearest health center. Among those who use less than one hour,
48(24.6%) have unmet need for spacing and 27(36%) among those who use more than one hour
(P=0.061). Unmet need for limiting count for 39 (20.0%) and 12(16.0%) for those who use more
than one hour (P=0.452).When asked if they are aware of availability of FP methods, 224(83.0%)
reported that they are aware and 46(17%) said that they are not aware. Among those who reported
they are aware, 57(25.4%) have unmet need for spacing, who said that they are not aware
18(39.1%) (P=0.059). Unmet need for limiting counted for 43(19.1%) for those who are aware and
8(17.3) for those who are not aware (P=0.776). Respondents were asked if they have been refused
of FP before, of 270; 24(8.9%) said that they have been refused while 246(91.1%) reported that
they have not been refused. Among those who reported being refused, 5(20.8%) have unmet need
for spacing (P=0.426) wile 2(8.3%) have unmet need for limiting (P=1.666).The convenience of
service hours was assessed in this study. Among respondents, 231(85.6%) said that the opening
hour are convenient and 39(14.4%) reported that opening hours are not convenient. Among those
who said that opening hours are not convenient, 63(27.2%) have unmet need for spacing (P=0.652)
and 47(20.3%) have unmet need for limiting (P=0.136).When asked if they have attended any
antenatal consultation (ANC) during pregnancy period, 232(85.9%) reported that they did while
38(14.1%) reported that they did not. Unmet need for spacing counted for 60(25.8%) among those
who have attended for ANC and 15(39.4%) among those who have not attended. Unmet need for
limiting counted for 45(19.3%) among those who have attended for ANC and 6 (15.7%) among
those who have not attended. Respondents were asked who take decision to use FP. Among
respondents 132(48.9%) reported joint decision among wife and husband and 138(51.1%) reported
that the decision is taken by husband. Unmet need for spacing counted for 11(8.3%) among those
who reported joint decision and 64(46.3%) (P<0.001). Among those who reported that the decision
is taken by husband and unmet need for limiting counted for 10(7.5%) among those who reported
joint decision, for those who reported that it is husband who take decision 41(29.7%) have unmet
need for limiting (P<0.001).

www.bjmhr.com 45
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
Multiple logistic regression of variables that have influence on unmet need for spacing and
limiting birth among women of reproductive age in Rubavu District, Rwanda
Variables which show significant association with the dependent variable were recruited to
estimate the likelihood of unmet need for spacing and limiting birth (Table 4). According to this
study, women who support that contraceptives methods improve standard of life have a 55.5%
reduction in the odd of having unmet need for spacing relative to those who do not support
it(OR=0.445;CI=0.222–0.892;P=0.023). Contraceptive methods cause headache is not statistically
significant with unmet need for spacing (P =0.592). Women who reported that contraceptive
methods can cause weakness were more than two times more likely to have unmet need for spacing
compared to those who did not report it (OR=2.879; CI=1.428–5.805; P=0.003). Women who
reported joint decision with their husband to use contraceptive methods had a 52.8% reduction in
the odd of having unmet need for spacing relative to those the decision is taken by husband
(OR=0.472; CI=0.286–0.778; P=0.003). Women who reported that the decision of using family
planning is taken by husband were more than two times more likely to have unmet need for spacing
relative to those who reported joint decision. According to the results of this study, women who
reported that contraceptive method cause headache were more than two times more likely to have
unmet need for spacing relative to those who did not report it (OR=2.240; CI=1.068–4.696;
P=0.033). Contraceptive method cause weakness was not statistically significant with unmet need
for limiting (P=0.904).Women who reported joint decision to use contraception with their husband
have a 43.9% reduction in the odd of having unmet need for limiting relative to those who reported
that the decision is taken by husband. (OR=0.561; CI=0.367–0.858; P=0.008). Women who
reported that the decision of using contraception is taken by husband were more than two times
more likely to have unmet need for spacing relative to those who reported joint decision
(OR=2.283; CI=1.074–4.856; P=0.032).

www.bjmhr.com 46
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
Table 1: Unmet need for spacing and limiting by knowledge on contraceptive methods.

Variables
Women (n) Percent Unmet need P-value Unmet need P-value
for spacing for limiting
Yes No Yes No
Number of methods
Known: 0.198
Know ≤ two methods 68 25.2 23 45 15 53 0.440
Know > 3 methods 202 74.8 52 150 35 67 0.258
Source of information^:
Radio 0.564
0.742
Yes 90 33.3 27 63 16 74
No 180 66.7 48 132 35 147
Television 0.698 0.262
Yes 13 4.8 3 10 4 9
No 257 95.2 72 185 47 210
Neighbor 0.521
0.776
Yes 46 17.0 11 35 8 38
No 224 83.0 64 160 43 181
Health center 0.4 14
0.575
Yes 144 53.3 37 107 29 115
No 126 46.7 38 88 22 104
Books 0.332
0.120
Yes 65 24.1 5 50 8 57
No 205 75.9 60 145 43 62
Community health workers 0.154
0.057
Yes 159 58.9 39 120 24 135
No 111 41.1 36 75 27 84
Community meeting 0.689
1.000
Yes 8 3.0 3 5 2 6
No 262 97.0 72 190 49 213
Know where to get methods^:
Health center/post (constant)
CHW 0 .640
0.615
Yes 238 88.1 65 173 46 92
Non 32 11.9 10 22 5 27
Pharmacy 0.203
0.363
Yes 49 18.1 10 39 7 42
No 221 81.9 65 156 44 177
District hospital 0.262
0.431
Yes 53 19.6 18 35 8 45
No 217 80.4 57 160 43 174

www.bjmhr.com 47
 Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
Table 2: Unmet need for spacing and limiting by attitude toward contraceptive methods
Variables
Women (n) Percent Unmet need P-value Unmet need P-value
for spacing for limiting
Yes No Yes No
Contraceptive methods control
birth (n=270) 0.149
0.119
Agree 211 78.1 63 148 44 167
Disagree 59 21.9 12 47 7 52
Contraceptive methods use
improves standard of life (n=270) 0.001
0.075
Agree 215 79.6 50 165 36 179
Disagree 55 20.4 25 30 15 40
Contraceptive methods reduce
morbidity and mortality of 0.14 0
0.101
mothers and children (n=270)
Agree 204 75.6 52 152 34 170
Disagree 66 24.4 23 43 17 49
Contraceptive methods can 0.149
0.672
cause cancer (n=270 )
Agree 73 27.0 25 48 15 58
Disagree 197 73.0 50 147 36 161
Contraceptive methods enhance
marital unfaithfulness (n=270) 0.455
0.129
Agree 102 37.8 31 71 24 78
Disagree 168 62.2 44 124 27 141
Contraceptive methods can
decrease sexual pleasure (n=270) 0.365
0.316
Agree 100 37.0 39 61 22 78
Disagree 170 63.0 44 126 29 141
Next born can have congenital
malformation 0.198
Agree 58 21.5 20 38 N/A N/A
Disagree 212 78.5 55 157
Contraceptive methods can
cause backache (n= 270) 0.069
0.077
Agree 69 25.6 25 44 18 51
Disagree 201 74.4 0 151 33 68
Contraceptive methods
cause headache (n=270) <0.001
<0.001
Agree 102 37.8 44 58 33 69
Disagree 168 62.2 31 37 18 150
Contraceptive methods can
cause hypertension (n=270) 0.065
0.232
Agree 72 26.7 26 46 17 55
Disagree 19 73.3 49 149 34 64
Contraceptive methods can
cause weakness (n=270) <0.001
0.001
Agree 115 42.6 54 61 32 83
Disagree 155 57.4 21 134 19 136
Contraceptive methods can

www.bjmhr.com 48
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
cause weight gain (n= 270) 0.070
0.086
Agree 89 33.0 31 58 22 67
Disagree 181 67.0 44 137 29 152
Contraceptive methods can
cause loss of menstruation (n=270) 0.054
0.053
Agree 81 30.0 29 52 21 60
Disagree 189 70.0 46 143 30 159
Contraceptive methods might
lead to permanent sterility (n=270) 0.077
Agree 63 23.3 23 40 N/A N/A
Disagree 207 76.7 52 155

www.bjmhr.com 49
 Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967

Table 3: Unmet need for spacing and limiting by availability and accessibility of contraceptive methods
Variables
Women (n) Percent Unmet need P-value Unmet need P-value
for spacing for limiting
Yes No Yes No
Know health center in the
nearby that provides FP (n=270) 1.000 1.000
Yes 269 99.6 75 194 51 218
Non 1 0.4 0 1 0 1
How close is the nearest
health center (n=270) 0.061 0.452
Less than 1 hour 195 72.2 48 147 39 156
More than one hour 75 27.8 27 48 12 63
Awareness of availability
of FP methods (n=270) 0.059 0.776
yes 224 83.0 57 167 43 181
No 46 17.0 18 28 8 38
Refused of FP before (n=270) 0.426 1.666
Yes 24 8.9 5 19 2 22
No 246 91.1 70 76 49 197
Reason of being refused of
FP (n= 24) 0.485 1.000
No menstruation 7 29.2 1 6 1 6
Too young 3 12.5 1 2 0 3
Service not available 5 20.8 0 5 0 5
Lack of husband’ consent 9 37.5 3 6 1 8
Convenience of service
hours (n=270) 0.652 0.136
Yes 231 85.6 63 168 47 184
Non 39 14.4 12 27 4 35
The time most convenient(n=39) 1.000 1.000
Early in the morning 13 33.3 4 9 2 11
Lunch hour 13 33.3 4 9 1 12
Evening/tonight 2 5.1 0 2 0 2
Weekend days 11 28.2 4 7 1 10
Attendance of ANC during
pregnancy period (n=270) 0.082 0.598
Yes 232 85.9 60 172 45 187
No 38 14.1 15 23 6 32
Who take decision to use FP (n=270) <0.001 <0.001
Joint decision 132 48.9 11 121 10 122
Husband 138 51.1 64 74 41 97

Table 4: Multiple logistic regression of variables that have influence on unmet need for spacing and limiting bir
among women of reproductive age in Rubavu District, Rwanda

Variables Unmet need for spacing Unmet need for limiting

AOR 95%CI P-value AOR 95%CI P-value
Contraceptives improve
standard of life 0.445 0.222–0.892 0.023 — — —
Contraceptives cause
headache 1.200 0.613–2.346 0.595 2.240 1.068–4.696 0.033
Contraceptives cause
weakness 2.879 1.428–5.805 0.003 1.047 0.494–2.220 0.904
Joint decision to use
Contraceptive methods 0.472 0.286–0.778 0.003 0.561 0.367–0.858 0.008
Decision taken by husband 2.703 1.320-5.536 0.007 2.283 1.074–4.856 0.032

www.bjmhr.com 50
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967

DISCUSSION
This study examined the influence of knowledge, attitudes and accessibility of contraceptive
methods on unmet need for family planning among women of reproductive age in Rubavu
district, Rwanda. The study shows that with a large and strong family planning program
sensitization, socio-cultural barriers so far important may be removed. As our culture is
very pro-birth with many proverbs that encourage us to have more children such as: ‘Kagire
abana’ which means ‘May you have more children’ or ‘Nimusubireyo nta mahwa’, which
means ‘keep having children, it can’t hurt (10). Overall, fear of side effects of contraceptive
methods and the decision of husband to bear children have an impact on unmet need for
family planning. This fear of side effect could be defined as negative attitude toward
contraceptive methods and probably be because they do not have adequate information that
would aid in choosing an appropriate contraceptive method. These findings are supported by
evidences form different authors. The results of the study conducted in Kenya, showed that
women’s and men’s discussions about physiological side effects, such as high blood pressure
and dizziness, centered on the potential loss of productivity. Men and women indicated that
as a result of these side effects, individuals would be unable to continue working or fulfill
normal obligations within the household. Participants also discussed changes in libido as a
result of these side effects, which would also inhibit sexual activity, causing disruptions in
(11).
sexual relationships Pills and injectable contraceptives were most often implicated in
participants’ reported fears. Participants reported that the pill and injection were associated
with infertility, cancerous growths, especially following prolonged use. The two methods
were also associated with an increased chance of birth defects, especially when one failed to
(11)
adhere to the pill regimen, or received an expired injectable . In another study, which
assesses contraceptive use in Uganda, showed that most women heard myths and beliefs that
could hinder the successful promotion and adoption of the family planning services
(12)
.Results from this study revealed that the decision of husband to bear children has an
impact on unmet need for family planning. The results from the study are similar to those
from the study conducted by Lwelamira, Mnyamagola and Musaki in 2012 in Tanzania in
which women who reported joint decisions with their husbands on issues related to fertility
were more likely to be current users of modern contraceptives compared to those who
(13)
reported that the final decision is taken by the husband alone. (OR = 19.4, p<0.01) . The
results of the study conducted in Ghana showed that women whose partners approved of
modern family planning were 4.33 times more likely to use modern family planning than
those whose partners did not approve (14) .Those findings are supported by the results from the
study conducted in Kenya from which approval of use methods by the partner was

www.bjmhr.com 51
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
significantly associated with use of modern FP methods (OR =3.85, 95% C.I 2.093-7.083,
P=0.00)(15). The results of the study carried out in Ethiopia showed that women whose partner
was not supportive to contraceptives use were 3.34 (AOR = 3.34, 95 % CI: 1.26–8.90) times
more likely to have unmet need for FP compared to those women whose partner was
supportive (16). In Ethiopia married women whose partners did not support the use of FP
methods were 2.08 times more likely to have unmet need compared to those whose partners
support FP use (AOR=2.08, 95%CI: 1.46-9.408) (17) .The results of the research conducted in
Zimbabwe to assess determinants of unmet need for family planning in Zimbabwe showed
that unmet need is also determined by myths and misconceptions associated with the use of
contraceptives. Men who participated in the study believed that they cannot enjoy sex when
(18)
their wives are using contraceptives . Participants added that contraceptives make the
husband weak and reduces his performance during sexual intercourse. Respondents reported
that they fear to give birth to babies with deformities if they use contraceptives. The majority
of respondents also believed that prolonged use of contraceptives causes infertility. There is a
misconception that after using long-acting methods like Jadelle or IUCD which protect a
woman for many years from becoming pregnant, the ovaries will have been blocked and will
have run out of eggs when she wants to conceive. All these misconceptions emanate from a
lack of appreciation of how the reproductive system functions (18).
CONCLUSION
Based on the information collected on that Sample, negative attitude toward contraceptive
methods, influence of husband on the use of contraceptive methods influence significantly
unmet need for spacing. There should be a great need to increase reproductive health
education and include men in participation in family planning activities designed to improve
family planning practices in Rwanda. Campaigns against myths and misbelieves that
negatively affect the use of LACM should be intensified
ACKNOWLEDGEMENTS
My deepest gratitude goes to late professor peter Mwaniki , the institutional review board
(IRB) of the University of Rwanda, National Health Research Committee (NHRC) of the
Ministry of health and Rwanda Biomedical Center (RBC) the division of Maternal, Child and
Community Health who reviewed scientifically the work and granted ethical clearance.
REFERENCES
1. Cates WJ. Family planning :The essential link to achieving all eight Millennium
Development Goals. Contraception. 2010; 6 (81) :460-1.

www.bjmhr.com 52
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
2. Susheela S and Darroch EJ. Addition It Up: Cost and Benefits of Contraceptive
Service Estimates for 2012. New York : Guttmacher Institute and United Nations
Population Fund (UNFPA), 2012.
3. EngenderHealth. The SEED assessment guide for family planning programming .
New york .2011.
4. Townsend JW, Sitruk-Ware Williams K, Askew I,Brill K. New strategies for
providing hormonal contraception in developing countries. Contraception.
2011;83:405-9.
5. Richey C and Salem RM . Elements of success in family planning
programming.Population reports series,No 57 . Baltimore .2008.
6. PATH and United Nations Population Fund. (UNFPA).Meeting the need:
Strengthening family planning programs. Seattle,WA.2006.
7. National Institute of Statistics of Rwanda (NISR). Rwanda Demographic and Health
Survey (DHS) 2014/2015. Key findings . Kigali : NISR, 2015. 5.
8. National Institute of Statistics of Rwanda (NISR) and ICF. 2010 Rwanda
Demographic and Health Survey . Calverton,Maryland,USA : NISR and ICF
International. 2012.
9. Sachdev et al . Reproductive health and child health and nutrition in India.
Lancet.2011;377(9762):332-349
10. Muramutsa F. Knowledge Sharing Socio Cultural Factors Affecting Family Planning
Practice in Rwanda. 2007.
11. Alaii J Nanda G and Njeru A. Fears, Misconception and Side Effects of Modern
Contraception in Kenya: Opportunities for Social and Behaviour Change
Communication. Research Brief. Washington DC : FHI, 2012.
12. Asiimwe JB ,Ndugga P , Mushomi J and Manyenye NJP .Factors associated with
modern contraceptive use among young and old women in Uganda; a comparative
analysis. BMC Public Health.2014; 14(926): 1-14.
13. Lwelamira J, Mnyamaga G and Musaki MM. Knowledge, Attitude and Practice
Towards Modern Contraceptives Among Married Women of Reproductive Age in
Mpwapwa District, Central Tanzania. Curr Res J Soc Sci. 2012;4(3):235–45.
14. Eliason et al. Determinants of modern family planning use among women of
reproductive age in the Nkwanta district of Ghana: a case–control study. Reproductive
Health. 2014;11(65):1-10

www.bjmhr.com 53
Emmanuel et. al., Br J Med Health Res. 2017;4(9) ISSN: 2394-2967
15. Kisia PM, Koskei A,Too R, Chirchir A. Determinants of use of modern family
planning methods: A case of Baringo North District, Kenya. Science Journal of Public
Health.2014; 2(5):424-430.
16. Ewnetu G, Gedefaw A, and Tadese E. Determinants of unmet need for family
planning among currently married women in Dangila town administration, Awi zone,
Amhara regional state: A cross sectional study. Reprod Health. 2015; 12(42).
17. Getiye D, Mekonnen A and Abajobir AA. Prevalence and associated factors of un
met need for family planning among married women in Enemy district, Northest
Ethiopia: A comparative cross-sectional study. Glob J Med Res. 2013;4(13).
18. Chitereka J, Busiko. N. Determinants of unmet need for family planning in Zimbabwe,
Liverpool. Anson House 2010. accessed online at www.lath.com

BJMHR is
 Peer reviewed
 Monthly
 Rapid publication
 Submit your next manuscript at
[email protected]

www.bjmhr.com 54